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Managed Care Contracting: The Provider Perspective
Presented by:
Ron Lampert, LISW-AP (SC) LMSW (MI)
Mark Furlong, LCSW, MNA
Thresholds: Chicago, IL
Joined for Q&A by:
Lisa Lite-Rottmann, Addictions Program Specialist (NYS OASAS)
Melissa Janidlo, Director of Regulation, Contracting and Finance,
Managed Care Division (NYS OMH)
Managed Care TAC (MCTAC) Overview
What is MCTAC?
MCTAC is a training, consultation, and educational
resource center that offers resources to all mental
health and substance use disorder providers in New
York State.
MCTAC’s Goal
Provide training and intensive support on quality
improvement strategies including business,
organizational and clinical practices, to achieve the
overall goal of preparing and assisting providers
with the transition to Medicaid Managed Care.
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MCTAC Overview (cont.)
• MCTAC is partnering with OASAS and OMH to provide:
– Foundational information to prepare providers for
Managed Care
– Support and capacity building for providers
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tools
group consultation
informational training
assessment measures
– Information and training on the critical domain areas
necessary for Managed Care readiness
– Aggregate feedback to providers and state authorities
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What MCTAC Offers
• Foundational information to prepare for Managed Care
• Support and capacity building for providers
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tools
consultation
informational forums
assessment tools
• Critical information along each of the domain areas
necessary for Managed Care readiness
• Feedback to providers and state authorities on readiness
for Managed Care.
• MCTAC will serve as a clearing house for other Managed
Care technical assistance efforts
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Managed Care Technical Assistance Center
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What Providers Can Do to Make the
Most out of MCTAC Supports
• Designate a project team including:
– Executive leadership, Finance & Clinic leadership,
and Evaluation staff when available
• Complete the readiness assessment and
participate actively in MCTAC activities
• Commit to investing the time and effort
needed to assess, diagnosis, improve, and
monitor your organization’s operations,
business practices, and financial performance
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Managed Care Contracting
Contracting events to date:
In-person contracting sessions, featuring Adam Falcone (618 total
attendees)
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November 14: Rochester
November 25: Long Island
December 9: Manhattan
December 10: Albany
January 13: Manhattan
93% of respondents found the in-person contracting session useful.
Web-based offerings:
• December 17: Managed Care Contracting: The Plan Perspective,
featuring Harold Iselin and Whitney Phelps of Greenberg Traurig
• February 10: Contracting Overview and Office Hours with Adam
Falcone
• March 25: The Provider Perspective feat. Thresholds
MCTAC Participation
537 NYS licensed behavioral health agencies
have participated in a MCTAC training or
completed a managed care readiness
assessment
– 342 OMH Agencies (62%)
– 195 OASAS agencies (46%)
Drowning in Acronyms
FIDA
9
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Primary Goal: To help behavioral health providers improve their
quality of care while lowering healthcare costs.
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Agencies can access standardized outcome measurement tools and metrics
designed to facilitate and improve use of evidence based practices.
Questions?
Visit www.mctac.org to view past trainings, sign-up for
upcoming events, and access resources.
[email protected]
@CTACNY
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Ron Lampert, LISW-AP (SC) LMSW (MI)
Vice President of Healthcare Strategy
Thresholds, Chicago, IL
Mark Furlong, LCSW, MNA
Senior Vice President of Clinical
Operations
Thresholds, Chicago, IL
Respond to poll questions by selecting your answer when the poll opens.
You will see an option to participate in the polling pop up on your screen.
To participate in the survey questions, please enter your responses in the
“chat” box on the right side of your screen.
To ask our panelists a question, please enter your question in the “Q&A”
box on the right side of your screen.
You can also send a message to us using the chat box or email questions
to [email protected].
1959
Established
Comprehensive Approach: Housing, Employment, Recovery
7100+
$70
CAN HELP
1200+
75%
1500
Served annually
Million budget
Staff
Services Delivered in Community
Units of Housing Managed by Thresholds
Serving Chicago Metro area, Kankakee, and McHenry Counties
Survey Question #1
How do you feel about partnering
with MCOs / providers?
Please select your response in the pop up polling screen.
Learning Objectives
What to…
How to…
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Prepare
Present
Say to MCO
Negotiate product
Negotiate contract
Get signed contract
Avoid mistakes
The IHI
Triple
Aim
Survey Question #1 results
How to Prepare
Pick a point
person
Assemble your
team
Know your
costs
Know their
culture (is it a
carve out
MCO or a
health plan?)
What to Present
• Their business
challenge
• 2-page program
description
• Expected outcomes
and performance
guarantees
What to Say
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•
•
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What you do
Who you
serve
Why you’re
special
Be a teacher,
seek a teacher
Survey Question #2
What is your biggest fear about
contracting with MCO’s?
Please type your answer into the
“question box” on the right
Negotiate
Reimbursement
Decide
margin
Know
your
cost
$
Review
rate
Think
longterm
Negotiate Product
Start with your
strengths
Do not over
commit
Triple check
contract
requirements
A Signed Contract
• Set due dates
• Do not cause
delays
• Be a friendly
nag
Lessons Learned
Understand
the whole
contract
Don’t sign if
it’s not right
Hard to
negotiate up
on rate
Be part of
the process
Know your
value
Brief Pause for Questions
Please type your questions into the
“question box” on the right
Survey #2 Answers
Your biggest
Survey Question #3
What is the greatest opportunity of
contracting with MCOs?
Please type your answer into the
“question box” on the right
Business
problem
Idea
Program
design
Outcomes
PILOT
PROGRAM
Rate
Scaling up
Thresholds/Cenpatico
Partnership
Why has it worked?
Designed
collaboratively
Relationship
Frequent
calls, follow
up
Focused on
one
challenge
Fits with
Triple Aim
Survey Answers #3
Questions and Comments
Thank You!
[email protected]
[email protected]